TY - JOUR
T1 - Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy
T2 - the SEAL score
AU - Ubels, Sander
AU - Verstegen, Moniek
AU - TENTACLE—Esophagus Collaborative Group
AU - Klarenbeek, Bastiaan
AU - Bouwense, Stefan
AU - van Berge Henegouwen, Mark
AU - Daams, Freek
AU - van Det, Marc J
AU - Griffiths, Ewen A
AU - Haveman, Jan W
AU - Heisterkamp, Joos
AU - Koshy, Renol
AU - Nieuwenhuijzen, Grard
AU - Polat, Fatih
AU - Siersema, Peter D
AU - Singh, Pritam
AU - Wijnhoven, Bas P.L.
AU - Hannink, Gerjon
AU - van Workum, Frans
AU - Rosman, Camiel
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2022/9
Y1 - 2022/9
N2 - BACKGROUND: Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.METHODS: This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.RESULTS: Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.CONCLUSION: The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
AB - BACKGROUND: Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.METHODS: This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.RESULTS: Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.CONCLUSION: The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
UR - https://www.scopus.com/pages/publications/85136908883
U2 - 10.1093/bjs/znac226
DO - 10.1093/bjs/znac226
M3 - Article
C2 - 35759409
AN - SCOPUS:85136908883
SN - 0007-1323
VL - 109
SP - 864
EP - 871
JO - The British journal of surgery
JF - The British journal of surgery
IS - 9
ER -